HCPCS Level II › J codes J1815 Insulin injectionInjection, insulin, per 5 units
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 8 units per day (clinical), rationale: Clinical: Society Comment Outpatient hospital: max 200 units per day (clinical), rationale: Clinical: Data DME supplier: max 0 units per day (clinical), rationale: CMS Policy Medicare pricing for J1815 Physician Fee Schedule (CY 2026, RVU26D) Status E: excluded from the PFS by regulation.
Payer policies and prior authorization for J1815 Payer coverage policies that name J1815 J1815 appears in 5 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Complementary and Alternative Medicine (0388) listed, no stance (range J1811-J1815) Jun 25, 2026 payer document Aetna Diabetes Tests, Programs and Supplies (0070) covered if criteria are met Feb 20, 2026 payer document Aetna Infusion Pumps (0161) covered if criteria are met Mar 31, 2026 payer document Aetna Injectable Medications (0020) listed, no stance (range J0278-J2543) Mar 5, 2026 payer document Aetna Intermittent Intravenous Insulin Therapy (0742) listed, no stance (range J1811-J1815) Nov 26, 2025 payer document
Medicaid fee-for-service AZ: $0.22 (outpatient_hospital), effective Oct 1, 2024 FL: $8.00 (physician_administered_drugs), effective Jan 1, 2026 IN: $0.11 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2024 KS: $0.13 (default), effective Jul 1, 2023 KY: $0.00 (asc), effective Jan 1, 2026 LA: $0.30 (professional), effective Jul 1, 2026 MS: $0.61 (comprehensive), effective Jul 1, 2026 NE: $0.23 (injectables), effective Jul 1, 2026 OH: $0.95 (provider_administered_drugs), effective Jan 1, 2022 OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026 TX: $0.50 (healthy_texas_women, Clinic/Group Practice, non-facility), effective Sep 1, 2025 VA: $0.87 (medical), effective Jul 1, 2021 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $0.12 (professional_administered_drugs), effective Jul 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.